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"�Fnmr eslyr�ed. �sam i2 tyyewriter+ �a"s�7'-'+�� <br /> or <br /> NON-HAZARDOUS 1 Generator s US EP ID No Manrles oc No 2 Page <br /> WASTE MANIFEST D of <br /> 3 Gengrator's Name and Mailing Address 4 Generators Phone( ) d Z` <br /> S Transporter 1 Company Name6 U P ID Number A Tran Driers Phone <br /> - c7 L/ D Zl <br /> 7 Transporter 2 Company Name 8 US tPA 1D Number B Transporter's Phone <br /> i <br /> 9 Designaled Facilely Name and Site Address 10 US EPA M Number C Facllily s Phone <br /> 7/VV/907_Ec', 4 <br /> 2-y80 f9-rAazs c 1 <br /> /kJ41341UZ( <br /> 11 waste Shipping Name and Description 12 Containers 13 <br /> 14 <br /> TolaUl <br /> No Type Ouantty Vt/Vo <br /> l <br /> � <br /> µ <br /> G b <br /> E <br /> IN <br /> E ` <br /> R i <br /> ` A C <br /> T _ <br /> O Y <br /> R z <br /> it <br /> d <br /> r: <br /> D Adddonal Dcsc rp'�ons for N,2.e ials Usled Abotic E Handbno Codes for Wastes Listed Abcve <br />�r <br /> r <br />{ .5 Special HanDlrng mslrucl3ons a-d Add1lonal infc,rV on <br /> I 1, <br /> 1 <br /> t <br /> r 5 GENERATORS CERTIFICATION Icer y I e ro t s desc,bed aDo,e en r c man.est ore'ot-.:iec1 o'CCC of regu+al,c— or repore-c proper o spe,al cf Ha7ardoLs 1 es e <br /> r PnnteorT ped.V2^e S1 r Vor.n D. "ar <br /> U LCJ L C " <br />} T L7 Trzr•spoler,, ACknpAle0De7e'1 Of Rece P.Of IJa ais <br /> R <br /> A P .r 7L pod rvam � I Sig^ia,ore Vor h O.v <br /> t �r <br /> , C -r <br /> b 18 Transporter 2 Ackno%%leoge ^'of Rece pt of Aa e a's <br /> r R <br /> T PrIn.EO,i viced Name Signt.c e 1,on n D.y Year <br /> E <br /> R <br /> 19 D screpancy Ino.cation Space <br />`r <br /> F <br /> A <br /> t C <br /> I <br /> L 20 Fac h y 0>%ner or Opefa.or Cerihcal.On of rcce pt of i as.e mate als covered by his r-amfest except as no.ed m Lem 19 <br /> I <br /> Printedr'TJ ped Name Sinn- Aaom7 Cav Yea, <br /> Pnnled by J J KELLER 8 ASSOCIATES INC 12-BLS-05 Rev 2/98 <br /> Neenah W15a957-0368 <br /> ORIGINAL -- RETURN TO GENERATOR <br />